Provider Demographics
NPI:1639489461
Name:MERCHANT, MUNIR M (RPH)
Entity Type:Individual
Prefix:MR
First Name:MUNIR
Middle Name:M
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WANDERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092
Mailing Address - Country:US
Mailing Address - Phone:801-262-6980
Mailing Address - Fax:801-263-6503
Practice Address - Street 1:5235 GREENPINE DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123
Practice Address - Country:US
Practice Address - Phone:801-262-6980
Practice Address - Fax:801-263-6503
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14638317011835G0303X
WY33521835G0303X
IDP58141835G0303X
AZS0179351835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric